Mayo Clinic Health System added about 150 colonoscopies a month in Eau Claire, Wis., by moving appropriate patients from anesthesia care to nurse-administered conscious sedation.
The change started with a staffing problem.
“We had a massive shortage of CRNAs post-COVID,” Prathibha Varkey, MD, president of Mayo Clinic Health System, said at Becker’s 16th Annual Meeting in April. “This was a problem across the country, and we had a massive backlog of colonoscopies.”
A Mayo gastroenterologist worked with one of the system’s AI medical directors to “marry an evidence-based protocol for taking complex anesthesia and moving it to conscious sedation where appropriate,” Dr. Varkey said. “Just by doing that, within 30 days, you have 150 more colonoscopies being done per month in that one particular town.”
Dr. Varkey said the system has used the AI-based algorithm for about five years. It sorts patients between “conscious sedation by nurses versus the use of complex anesthesia by CRNAs or anesthesiologists.”
The change raised colonoscopy rates 30% in Eau Claire, she said, and “has just simply taken off” across the enterprise. A similar tool helps decide whether a patient should get a colonoscopy at a critical access hospital or a hub hospital based on comorbidities.
“It does not take away from the physician oversight,” she said.
Health systems lean heavily on anesthesia for routine GI work. At more than 600 hospitals, the share of outpatient colonoscopies with anesthesia assistance rose from 16.7% in 2006 to 58.1% in 2015, a 2019 study in Clinical Gastroenterology and Hepatology found. Median costs per procedure ran $182 to $233 higher with anesthesia, depending on payer. An American College of Gastroenterology task force said this fall that current rates are likely higher.
Michael Lewis, MD, chair of anesthesiology at Detroit-based Henry Ford Health, said removing sedation-based work from the department’s portfolio is one of its main tactics as anesthesia pay falls behind costs.
“We’re very good at giving anesthesia for GI cases. And it’s popular with the GI docs, who now do not know how to do a procedure without anesthesia. And it’s very popular with the patients,” Dr. Lewis said at Becker’s Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference. “But it’s an expensive service to run when a sedation nurse can give sedation for the same procedure.”
The department is investing in higher-margin services such as transplant and cardiac, he said.
Facilities are increasingly covering that cost through stipends. The share of ASCs expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, according to VMG Health. Among California hospitals, 57.4% paid an anesthesiology stipend in 2021, up from 35.5% in 2002, a 2025 Health Affairs study found.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
